In health reporting, learn to question your underlying premise

I have been writing about young people’s health for much of the four years I’ve been a journalist. It was back in 2014 that I first reported on research on the health effects of trauma — the science of adverse childhood experiences (ACEs) and the ability to predict future health outcomes based on traumatic episodes like abuse that a person might experience as a child. This approach to childhood trauma has garnered a lot of attention in recent years and is frequently cited by health professionals. The concept is one that I’ve carried with me as I’ve more recently reported on mental health and foster youth, juvenile justice-involved youth, and homeless youth.

Earlier this year, though, I read a piece about child abuse in The New Yorker by historian Jill Lepore. Lepore expresses skepticism about the ACEs approach:

The murky science of risk assessment relies on attempts to quantify ‘trauma’ and ‘adversity,’ which, on the one hand, are meaningful clinical concepts but, on the other hand, are proxy terms for poverty … The noble dream here is that, if only child-protective agencies collected better data and used better algorithms, children would no longer be beaten or killed. Meanwhile, there is good reason to worry that the ACE score is the new I.Q., a deterministic label that is being used to sort children into those who can be helped and those who can’t. And, for all the knowledge gained, the medicalization of misery is yet another way to avoid talking about impoverishment, destitution, and inequality.

Lepore’s criticism — that “trauma” has become a proxy word for poverty — struck me as important. I had originally planned to do my fellowship project on whether effective mental health care is reaching the marginalized kids who need it the most. But Lepore’s thoughts about trauma and poverty got me questioning the premises I’ve accepted in reporting on mental health.

If adverse childhood experiences are good predictors of mental health problems in adulthood, is mental health care as we conceive of it (talk therapy, medication, etc.) treating the symptom but not the cause? That’s in no way meant to diminish the importance of delivering timely and high-quality mental health treatment to those who need it. But I take Lepore’s point to heart — that we can’t avoid talking about the need to address inequality and the root causes of poor mental health.

In my interviews for this project, the concept of “social determinants of health” came up several times. I’ve come into contact with doctors who believe that the health care system must help address issues of inequality, such as Dr. Margot Kushel at UCSF, who works with older homeless adults. A recent Bloomberg editorial addressed work being done by states to use Medicaid dollars to help homeless beneficiaries get housing. Poverty alleviation as an engine for better community health outcomes is not a “sexy” topic in the broader scheme of health reporting, but I also think there’s a reason that Sen. Bernie Sanders’ focus on addressing inequality caught on like wildfire. People care about these issues.

I don’t know that I’m in a position to give advice to other reporters; I have not been doing this long enough. But I do know that in my own work, I have to do more than report on the positives or negatives of this or that health policy. I have to question the premises I’ve accepted and keep looking at the bigger picture.

[Photo by Richard Masoner via Flickr.]